PB2125: VCD VERSUS VRD‐BASED REGIMENS AS INDUCTION THERAPIES IN PATIENTS WITH PRIMARY MULTIPLE MYELOMA (MM): HIGHLIGHTING STRATEGIES THAT ACTUALLY WORK.
Authors: Olga Novosad, Irina Kriachok, Tymur Rudiuk, Ian Pastushenko, Iryna Tytorenko, Olena Aleksik, Natalia Shudrak, Tetiana Kadnikova, Olexandr Horbach, Ulyana Melnyk, Larysa Mykhalska, Yana Stepanishyna, Nazar Shokun
Journal: HemaSphere (2023)

Background: Treatment outcomes for multiple myeloma (MM) patients have improved significantly over the past decade.Despite improvements in diagnostic procedures and prognostic factors leading to a more effective approach to risk stratification, the main contributing factor has been improved induction regimens. Bortezomib-based triplet regimens VRd and VCd are the two most common induction regimens used in the first line for primary patients with MM. However, data on comparative efficacy and outcomes remain inconsistent. With this in mind, we conducted a retrospective analysis in 6 centers in Ukraine to compare the results of VRd and VCd in patients with newly diagnosed MM. Aims: The primary endpoint was to evaluate the best response to VCd/VRd treatment with or without ASCT, PFS and OS for newly patients with MM. The second point was determined clinical significance of MRD as a predictor of relapse. Methods: We conducted 128 newly diagnosed patients with MM (median age: 52.5, range: 31-74 years; males:68, females:60) from 2011 to 2023. VCd and VRd regimen received 56.2% and 43.8% patients, respectively (p<0.05). Response was evaluated at the end of 3-4 cycles and the end of treatment as per IMWG criteria. Patient`s characteristics were similar in both groups as regards to ISS stage and median age. Results: The ORR was higher in the VRd group compared with VCd (91% and 81.9%, respectively, p<0.05. CR/sCR rates were superior in the VRd arm also; 37.3 % vs 26.3%, p< 0.05. Considering the higher percentage of CR achieved in the group of patients with lenalidomide-containing regimen, we analyzed the median rapid early response but it was similar for the two groups (3.1 months for VRd vs 3.2 months for VCd). Mean of median PFS was 47.9 months and median OS was not reached. PFS and OS were strong correlated with therapy response. The 5-year OS and PFS were significantly longer in patients who achieved ≥VGPR vs MR/progression [77% vs 64% (p=0.008) and 50% vs 20%, (p<0.000), respectively]. There was difference in the relapse rate between VRd and VCd (5% vs 18%, p<0.05). Thus, analysis of 2 groups of patients depending on the course of treatment revealed a significant reduction in the risk of recurrence in the next 5 years when using the VRd regimen compared with VCd (5-year PFS 60% vs 25%, p=0.03). Transplantation, as before, takes an important place in the treatment of patients with primary MM, since it significantly improves the level of PFS in comparison with patients who did not receive ASCT (5-year PFS 43% vs 35%, p=0.0001). But there was no difference in OS between the 2 regimens (p=0.65). Unfortunately, we did not find statistically significant data on MRD status before and after ASCT, which improve survival. Possible that fact due to the small group of patients in whom MRD was detected. Summary/Conclusion: Our data suggest that a triplet regimen, followed by high-dose therapy and ASCT is the best standard of treatment for primary patients with MM. According to the results of our study, the use of the regimen VRd leads to a deeper response and better progression free survival in patients in first line therapy. Perhaps in the future this schema will be the best choice for primary patients with MM. Keywords: Survival, Minimal residual disease (MRD), Stem cell transplant, Multiple myeloma